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Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational M PowerPoint Presentation
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National NSI Conference 2006 – Ireland 22nd April 2006. Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational Medicine, Royal Free Hospital, London. UK. Membership. Trades unions – Unison, RCN, BMA

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slide1

National NSI Conference 2006 – Ireland

22nd April 2006

Dr Paul Grime MBChB MSc MRCPI MFOM

Chair, Safer Needles Network UK

Consultant/Honorary Senior Lecturer in Occupational Medicine,

Royal Free Hospital, London. UK

membership
Membership

Trades unions – Unison, RCN, BMA

Clinicians and professional organisations –

occupational health, infection control, perioperative care,

risk management and anaesthetics

Manufacturers – ABHI

Interested parties – SCIEH, HPA, BDA, WAG

Observers – NHS Employers, PaSA, DH, HSE

network aims
Network Aims

Reduce number of needlestick injuries

Preventative measures

Safer systems of working

Provision of safer needles

Improved training and education

Use of standard precautions

Safer disposal of sharps

Promotion of best practice

network s objective
Network’s Objective

In January 2005, NHS Employers issued national guidance to reduce the risk needlestick injuries and for their prevention and management.

The Network’s principal objective is to facilitate implementation and compliance with the guidance so that NHS Trusts conduct proper risk assessment, surveillance and reporting procedures, training and education and make available safety devices.

safer needles campaign
Safer needles campaign

Coalition building, informing and influencing stakeholders

Media activity and raising awareness of the risks

Maintaining relationships with bodies who have a duty of care for employees and political campaigning

EPINet and HPA surveillance data

Monitoring the effectiveness of the national guidance

through national audit

Website: needlestickforum.net

Annual conferences and regional roadshows

what do we want
What do we want?

The provision of training, education and medical devices incorporating safety engineered protection mechanisms which will lead to a significant reduction in the incidence of blood and body-fluid exposures. This can be achieved by:

Implementing proper surveillance and reporting procedures

Providing ongoing training and education, locally and nationally, of healthcare workers in preventative measures and safer working practices

Making available medical devices incorporating safety engineered protection mechanisms to all healthcare workers in the workplace, where such devices will reduce the risk of blood and body-fluid exposure.

Health Service Circular and guidance to Trust Chief Executives and

NHS Managers to minimise the incidence of sharps and NSI

Proper surveillance and reporting of NSI and monitoring of the

reduction as a result of the introduction of safer needles

needle stick injury
Needle-stick Injury
  • Definition, epidemiology, transmissions
  • Prevention
    • Safe systems of work
    • Safety engineered devices
  • Management of exposure incidents
needle stick and sharps injuries
Needle-stick and sharps injuries

Needle-stick injuries (NSIs),

other sharp medical devices,

bone, teeth (Percutaneous)

Splash (Muco-cutaneous)

Blood/Body fluid exposure

Potential for transmission of blood borne virus, e.g.

HBV, HCV or HIV, or other transmissible agents

slide10
HCV 48%

HIV 24%

HBV 9%

Percutaneous 78%

Nurses 45%

Doctors 37%

Health Protection Agency, Centre for Infections Surveillance of Occupational Exposure to Blood-Borne Viruses in Healthcare Workers: Seven-year Report: 1st July 1997 to 30th June 2004

slide11

Health Protection Agency, Centre for Infections Surveillance of Occupational Exposure to Blood-Borne Viruses in Healthcare Workers: Seven-year Report: 1st July 1997 to 30th June 2004

  • 58% during procedure
  • 37% after procedure, before disposal or during/after disposal
reported transmissions
HIV

UK: 5 definite since 1984 (4 have died)

12 probable

World: 102 definite

217 probable

HCV

UK: 9 definite since 1997

World: 78+?

Reported transmissions
prevention safe systems of work
Prevention: Safe Systems of Work
  • Standard (Universal) Precautions
  • Don’t re-sheath
  • Don’t pass hand to hand
  • Dispose of sharps at point of use
prevention safe systems of work14
Prevention: Safe Systems of Work

Protective Equipment

  • Gloves
  • Cover cuts/abrasions with waterproof dressings
  • Eye Protection
prevention safe systems of work16
Prevention: Safe Systems of Work
  • Induction is not enough!
  • Safety must be integral to organisational culture & everyday practice
prevention safety engineered devices
Prevention: Safety Engineered Devices
  • Shielded/retractable needles & cannulae
  • Blunt suture needles/cannulae
  • Needle-free systems
  • www.pasa.nhs.uk
prevention safety engineered devices18
Prevention: Safety Engineered Devices
  • Local evaluation
  • Cost in use
  • US Needlestick Safety and Prevention Act 2000
management of body fluid exposure incidents
Management of Body Fluid Exposure Incidents

Incident

Assess the risk of BBV transmission.

Consider:

  • Circumstances of exposure:
  • Percutaneous / Mucocutaneous
  • High / Low risk
  • Source Patient Status:
  • HIV
  • HCV
  • HBV
  • Exposed member of staff:
  • HBV immune status
  • Contraindications to PEP for HIV
  • Action to minimise the risk of BBV transmission:
  • Hep B booster / HBIg
  • PEP for HIV

Consider safer systems of work to prevent further incidents

  • Report:
  • HPA CFI
  • RIDDOR

Follow up to confirm occupational BBV transmission has not occurred

principles of management of needlestick injury bbfe
Principles of Management of Needlestick Injury (BBFE)
  • Assess risk of BBV transmission
  • Action to minimise risk of BBV transmission
assess risk of bbv transmission
Assess risk of BBV transmission

Consider:

  • Circumstances of exposure
  • Source patient
  • Exposed healthcare worker
circumstances of the exposure
Circumstances of the Exposure
  • Percutaneous
    • Deep/superficial
    • Visible blood on the device
    • Solid/hollow bore needle
    • Volume of blood innoculated
  • Muco-cutaneous
  • 2-way exposure? (e.g. NSI during EPP)
source patient
Source Patient
  • Known/unknown
  • HIV, HBV, HCV
  • Known Infection
  • Co-infection
  • Risk Factors
  • Consent for testing
exposed healthcare worker
Exposed Healthcare Worker
  • Hepatitis B immunity
  • General Immunity
  • Contraindications for PEP
action to minimise the risk of bbv transmission
Action to minimise the risk of BBV transmission
  • Hepatitis B immunoglobulin
  • HIV PEP
reporting
Reporting
  • Local
  • National e.g. HPA
  • Legal requirements e.g. RIDDOR
consider preventable factors
Consider preventable factors
  • Inform measures to continuously improve safety
management of body fluid exposure incidents30
Management of Body Fluid Exposure Incidents

Incident

Assess the risk of BBV transmission.

Consider:

  • Circumstances of exposure:
  • Percutaneous / Mucocutaneous
  • High / Low risk
  • Source Patient Status:
  • HIV
  • HCV
  • HBV
  • Exposed member of staff:
  • HBV immune status
  • Contraindications to PEP for HIV
  • Action to minimise the risk of BBV transmission:
  • Hep B booster / HBIg
  • PEP for HIV

Consider safer systems of work to prevent further incidents

  • Report:
  • HPA CFI
  • RIDDOR

Follow up to confirm occupational BBV transmission has not occurred

reference
Reference

Appendix 2:

Needlestick Injury: Prevention and Management

in The Management of Health, Safety and Welfare Issues for NHS Staff,

NHS Employers January 2005